Continence Coach: Are You a Bladder Retraining Coach?

Prevalence of Urge Incontinence

  An estimated 17 million community-dwelling adults in the US have daily urinary incontinence (UI), and an additional 33 million suffer from the overlapping condition, overactive bladder (OAB).¹ Although UI and OAB occur far more frequently in women than men, symptoms become more prevalent with advancing age, the gender gap closing in the elderly.² Whether older persons are homebound or nursing facility residents, more than half in either setting are incontinent. Incontinence represents one of the leading common diagnoses among the aged and one of the top reasons for placing an individual in an institutional residence where care is provided by staff.³   Analyzing the National Health and Nutrition Examination Survey (NHANES)⁴ home interview data, researchers have found the overall prevalence among adult American women to be 23.7% for stress UI, 9.9% for urge UI, 14.5% for mixed UI, and 49.2% for any UI. When data for mild UI are excluded, the statistics are 14.0%, 5.9%, 12.6%, and 33.4%, respectively. The NHANES data cover persons age 20 years and beyond, but sample only those living independently in the community. In this analysis, prevalence of different types of incontinence varies over a woman’s lifetime, with prevalence of stress UI peaking in the fifth decade of life and gradually decreasing, presumably following treatment/intervention in middle age. Prevalence of urge UI begins to trend upward with age from the fifth decade. Prevalence of mixed UI gradually increases throughout a woman’s lifetime.⁴

A Catalyst for Comprehensive Continence Care

  For those of you working with older adult patients, these statistics are all well known. Where does this leave you with respect to the need to provide continence care? Often, incontinence diagnoses serve as the catalyst to assemble a comprehensive care team involving a specialty physician, the primary care provider, a physical therapist, hands-on caregivers, and possibly others. Because of the increasing incidence of urge UI, with or without the presence of stress UI, as a person ages, it is reasonable in this context to focus on OAB of which urge UI is a component. Underlying causes of the symptoms of urge UI — ie, leakage or lost control of even a small amount of urine upon the sudden urge or pressure to urinate and the inability to reach the toilet fast enough — may be neurological, bladder stones, or in men, due to prostate enlargement. Any of these can confound reaching an accurate diagnosis, but exactly why the bladder malfunctions remains somewhat of a mystery.

Bladder Retraining: Regaining Control over Urgency

  Depending on the circumstances, comorbidities, and a physician’s diagnosis, one of the most effective interventions, especially in combination with other tactics (including pelvic floor muscle exercises, dietary modifications, and medication) is bladder retraining. The bladder retraining program, typically spanning 6 weeks, is specifically designed to address symptoms of urge UI and OAB. It may be helpful for some (but not all) people with neurological symptoms. The goal of bladder retraining is to slowly increase the time between voids, and thereby decrease the number of trips to the toilet in a 24-hour period. It also aims to reduce the number of accidents of leaking urine before safely reaching the toilet, and thus can help with fall prevention.

Serving as the Coach

  The patient must have the determination to stick with the program so progress can be realized and sustained. The clinician — you! — can be an invaluable coach and motivator in making that happen. Although complex mental games or tasks or relaxing thoughts can help make the urge subside, teaching a patient how to perform contractions of the pelvic floor muscles when the urge strikes can be the best strategy. Another tip is to have patients roll up a bath towel and sit on the roll in a firm chair when having the strong urge to urinate.

  Above all, don’t let your patient be discouraged by setbacks. Bladder control problems can be worse when the patient is fatigued, distracted, anxious about a problem, tense and nervous, sick with a cold or stomach virus, or even when dealing with cold, rainy days. The National Association For Continence has an instruction pamphlet and chart to help your patients track progress. For details, further information, or to order, please visit the website (www.nafc.org). You are the coach. Many willing players are eager for your help.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.

1. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. Br J Urol Int. 2001;87(9):760 – 766.

2. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and the burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–336.

3. Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age and Aging. 1997;26:367–374.

4. Minassian VA, Stewart WF, Wood GC. Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol. 2008;111(2 Part I):324–331.